Rehabilitation -Acute vs Subacute: Understanding Your Options
When you or a loved one need to be in a rehabilitation facility, it can be a daunting task to determine where to place them and what the differences are between acute and sub-acute rehabilitation. Understanding these differences is important for rehabilitation expectations, your post rehabilitation care and insurance.
Here are the differences:
Acute Rehabilitation Care is for people needing more intensive rehabilitation. These are usually inpatient facilities. This setting usually provides for:
- A minimum of three (3) hours therapy a day and can include physical, occupational, speech and recreational therapy.
- Therapy is usually provided 5-7 days a week.
- Rehabilitation nursing staff are on duty 24/7.
- Facilitated through a case manager, there are regular meetings (in our case – weekly) between the patient and family and the therapist(s) nurse and/or doctor and social worker to discuss progress and determine a projected discharge date.
Important note: Insurance has a very specific methodology for determining progression towards discharge goals and this measurement determines at what point insurance will stop paying for acute rehabilitation. There are also limits on the number of days insurance covers acute rehabilitation. If a loved one needs acute rehabilitation and isn’t making the progress needed, see if they should go to a sub-acute facility. There are some differences between the two as noted below and there are insurance implications as well. Be sure to check with your insurance provider before making any decisions. Your case manager’s role is to help you understand your benefits and balance the needs of the patient with hospital/facility needs.
Subacute Rehabilitation Care is for people that aren’t quite ready for the intensive nature of acute therapy due to a number of reasons but they are ready for some level of rehabilitation care. This setting usually provides for:
- A maximum of three (3) hours per day and can include physical, occupational and speech therapy.
- Therapy is usually 3-5 days a week.
There are regular meetings similar to the acute setting. The big difference is the amount of therapy offered. Typically someone in a subacute facility will work up to an acute setting or return home and have assistance through home health care.
Important Note: One difference between the two facilities is restraints. Subacute facilities are not allowed to use restraints. When my dad was in acute rehabilitation the first, second and third time, he had ‘Houdini’ tendencies where he would get up and attempt to leave the bed…and fall. Sometimes, he got up and actually made it to the hallway and disappeared. Not for long though! My dad needed to be restrained because of these tendencies and the fact he had short term memory loss and confabulation. Being restrained sounds like a horrible thing, and nobody would want this to happen to them, yet when it means their safety, that’s what restraints are there for. It helped keep my dad safe. For this reason, subacute facilities weren’t an option for us.
The role of subacute and acute facilities varies from state to state. The common thread is they exist to help patients restore independence, or at least some level of functioning they had prior to what led them there. These employees work tirelessly to help our loved ones regain the ability to perform acts of daily living such as eating, bathing, and dressing just to name a few. Together, we are partners in our loved ones care.
It’s your turn: Have you or a loved one ever been in a rehabilitation facility? If so, what was your experience? What do you imagine would be the toughest part of being in a rehabilitation facility or having a loved on in rehabilitation? Please comment below!